Loneliness

Might COVID-19 Quarantine Lead to Chronic Social Isolation?

Isolated for health, yet it doesn't feel great to be cut off.

Posted May 24, 2020

A gym buddy lives in my neighborhood. Several days ago, I called her to arrange a walk together (with masks and social distancing). Our gym has been closed for two months, and I missed seeing her. “I would love to see you,” she said, “but I don’t leave my apartment. I have been outside only once in the past nine weeks. I don’t plan on going outside for weeks, maybe months, at least until they have a vaccine.“

The reason for her weeks of self-isolation was fortunately not due to any underlying medical condition that would make exposure to the virus particularly threatening. She is in excellent health, and her age and gender slightly decrease her risk of serious complications from the virus. The only other person in her household, her husband, leaves their home daily to go for his morning run and evening walk. He goes to the supermarket and will occasionally go for a bike ride with a friend. She knows he may be exposing her to the virus even though she does not leave her apartment. But Elly (not her real name) explained that her reason for her almost total isolation wasn’t fear of becoming sick, although of course, she took precautions to clean everything her husband purchased in the market. “No, that is not why I can’t go outside again,” she said. “It is how I felt the one time I left the apartment.“

“I went outside once about a month ago,” she continued. “I wore my mask and gloves, a hat, sunglasses, and long sleeves and felt totally protected. But when I walked on the sidewalk near my building, everyone I saw was wearing face masks. As I passed them, they stepped away from me onto the grass or road so they wouldn’t come too close. The whole experience made me terribly anxious. My whole body felt jittery, and I had to go back inside after a few minutes.”

After the call ended I wondered at the change in my formerly outgoing friend who loved to walk, explore new neighborhoods, and meet up with friends. Was the COVID-19 injunction to shelter at home, and the now strange appearance of people wearing face masks, triggering such anxiety that she will be unable to leave her home for the foreseeable future? Most of us who have been outside over the past several weeks have grown accustomed to seeing face masks and doing the avoidance step so we don’t come in close contact with others on the sidewalk. But Elly’s reluctance to leave her home and thus become accustomed to the COVID-19 street scene might be making it harder and harder for her to escape her social isolation. Was she really going to stay inside until there is a vaccine?

It was possible but unlikely that she was experiencing a disorder called social phobia. Avoidance of social interaction for fear of embarrassing oneself (or being judged) generates anxiety, thus causing a phobia about participating in social situations. Even if there is a desire to make friends and join in activities, the anxiety associated with this disorder is so great it is easier to stay home and avoid people. But Elly did not have social phobia. She seemed to know everyone in the gym, was active in several organizations, volunteered at a nearby museum, and had lots of friends.

Had she developed another disorder, agoraphobia? This mental disorder causes an individual to fear leaving home because of a fear of having a panic attack in public. The individual thus avoids being in crowded places, in an elevator, or on public transportation where he or she may feel trapped. And recent research has found agoraphobia to be highly prevalent among the elderly who may be fearful of leaving their homes because of poor eyesight, memory, or depression. But Elly was not elderly and had no history of panic attacks, or generalized anxiety of which panic attacks are a symptom. Interestingly, however, some of the symptoms of agoraphobia were similar to her response when she did venture outside, when she was around people social distancing themselves and wearing masks: significant anxiety, breathlessness, sweating, dizziness, and a fast heart rate.

Her response is probably not that different from that of many of us who still find it difficult to see toddlers wearing masks or having to be reminded by a friend not to come too close. But Elly retreated into the medically-sanctioned social isolation, the “sheltering at home,” with relief. And despite the fact that she is not in a high-risk group, she has no interest in departing from her social isolation, even as some of the injunctions against entering some types of public spaces (like hair salons) are being somewhat relaxed.

Pre-COVID-19, her social isolation would have been seen as a problem. It is defined as a willingness to avoid any contact with family and friends and the rejection of attempts by others to remove the isolation. It differs from the social isolation caused by the inability of individuals to leave their homes because of their age, frailty, lack of mobility, financial resources for transportation, and sickness. Now, of course, Elly’s isolation is seen as a means of protection against exposure to the virus.

But what if, as time goes on, Elly finds it more and more difficult to leave her home? Might her anxiety and discomfort at viewing a world no longer familiar because of face masks and social distancing reduce her desire to re-enter the world? No one knows how long we will be wearing face masks and not coming close to others on the sidewalk, in stores, restaurants, or any public place. Will her comfort in being in the safe and familiar environment of her home generate a like discomfort if she has to leave it? Might the “shelter at home” directive transition into a permanent lifestyle? She told me that she sees no reason to leave. Her husband supplies her with whatever she needs. She enjoys, she told me, looking out the window at the activity in the neighborhood. She has no desire to see anyone.

I hung up the phone, wondering if or when I would ever see my friend again.

References

“Late-life agoraphobia: a hidden cause of social isolation and suicidal risk?” Ritchie, K, European Psychiatry, 2013; 28: 1.